Discharge And Home Healthcare Guidelines

WOUND CARE. Explain the need to keep the surgical wound clean and dry. Teach the patient to observe the wound and report to the physician any increased swelling, redness, drainage, odor, or separation of the wound edges. Also instruct the patient to notify the physician if a fever develops.

ACTIVITY RESTRICTIONS. Instruct the patient to lift nothing heavier than 5 pounds for about 6 to 12 weeks and to avoid driving until her or his physician permits. Braking while driving may increase intra-abdominal pressure and disrupt the suture line. Most surgeons temporarily discourage activities that require pulling, pushing, or stretching—activities such as vacuuming, changing sheets, playing tennis and golf, mowing grass, and chopping wood.

SMOKING CESSATION. Encourage the patient to stop smoking and to attend smoking cessation classes. Smoking cessation materials are available through the Agency for Healthcare Research and Quality (http://www.ahrq.gov/) or the National Institute on Drug Abuse (http:// www.nida.nih.gov/).

COMPLICATIONS FOLLOWING SURGERY. Discuss with the patient the possibility of clot formation or graft blockage. Symptoms of a clot may include pain or tenderness in the calf, and these symptoms may be accompanied by redness and warmth in the calf. Signs of graft blockage include a diminished or absent pulse and a cool, pale extremity. Tell patients to report such signs to the physician immediately.

COMPLICATIONS FOR PATIENTS NOT REQUIRING SURGERY. Compliance with the regime of monitoring the size of the aneurysm by computed tomography over time is essential. The patient needs to understand the prescribed medication to control hypertension. Advise the patient to report abdominal fullness or back pain, which may indicate a pending rupture.

Abdominal Trauma

DRG Category: 188

Mean LOS: 4.9 days

Description: MEDICAL: Other Digestive System

Diagnoses, Age > 17 with CC DRG Category: 154 Mean LOS: 13.3 days Description: SURGICAL: Stomach, Esophageal, and Duodenal Procedures, Age > 17 with CC

^Abdominal trauma accounts for approximately 15% of all trauma-related deaths. Intra-abdom-inal trauma is usually not a single organ system injury; as more organs are injured, the risks of organ dysfunction and death climb. The abdominal cavity contains solid, gas-filled, fluid-filled, and encapsulated organs. These organs are at greater risk for injury than are other organs of the body because they have few bony structures to protect them. Although the last five ribs serve as some protection, if they are fractured, the sharp-edged bony fragments can cause further organ damage from lacerations or organ penetration (Table 1).

• TABLE 1 Injuries to the Abdomen
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